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Published on: May 28, 2019
The effect of tirofiban on ST segment resolution in patients with non-ST elevated myocardial infarction
Ozgür Bayturan1, Ali Riza Bilge, Cevad Seküri
1Department of Cardiology, University Hospital of Celal Bayar, Manisa, Turkey.
Insights
Adding tirofiban to conventional treatment significantly improved ST segment resolution in non-ST elevated myocardial infarction (NSTEMI) patients by 72 hours. This intervention did not increase major bleeding risks, suggesting a potential benefit for high-risk patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- ST segment depression in non-ST elevated myocardial infarction (NSTEMI) indicates a high risk of myocardial infarction (MI) and death.
- Early ST segment resolution is a crucial indicator of treatment efficacy and patient prognosis.
Purpose of the Study:
- To evaluate the impact of adding tirofiban to conventional therapy on ST segment resolution in NSTEMI patients.
- To assess the safety and efficacy of tirofiban in improving early ECG markers of reperfusion in NSTEMI.
Main Methods:
- A randomized controlled trial involving 64 NSTEMI patients.
- Patients were assigned to either conventional treatment or conventional treatment plus intravenous tirofiban for 72 hours.
- ST segment resolution was defined as >50% regression of ST depression on ECG.
Main Results:
- ST segment resolution was significantly higher in the tirofiban group (67.9%) compared to the conventional treatment group (32.1%) at 72 hours (P < 0.05).
- No significant difference in ST segment resolution was observed at 4 and 24 hours between the groups.
- Tirofiban treatment did not lead to an increase in major bleeding events, though minor bleeding showed a trend towards increase.
Conclusions:
- Adding tirofiban to conventional treatment enhances ST segment resolution in NSTEMI patients by 72 hours.
- Tirofiban appears to be a safe adjunctive therapy for NSTEMI, without significantly increasing major adverse cardiac events or major bleeding.
Abstract:
ST segment resolution in ST elevated myocardial infarction has independent predictive value for congestive heart failure and death at 30 days. ST segment depression in unstable angina pectoris (UAP) and non-ST elevated myocardial infarction (NSTEMI) predicts high risk of MI and death and may discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy. This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients. In the first group, 6 patients refused to participate further after giving initial informed consent while 1 patient in the tirofiban group dropped out. We had 26 patients (mean age, 59 years) in the conventional treatment group and 31 patients (mean age, 59 years) received also tirofiban. Tirofiban was administered by intravenous infusion over a 72 hour period. More than 50% regression of depression was considered to be ST segment resolution. The characteristics of the two groups were comparable (Table I). The ST segment resolution evolution did not differ at the 4th and 24th hours between the two groups. Significant differences occurred in the 72nd hour ECG (Table III). ST resolution was present in 67.9% of the tirofiban patients and in 32.1% of the conventional treatment group (P < 0.05). Tirofiban treatment was not associated with an increase in major bleeding even though there was a trend toward an increase in minor bleeding cases and did not influence the occurrence of refractory angina pectoris.
